Nowadays the problem of cultural care is particularly acute. Many nurses tend to polish professional caring skills ignoring the cultural competence in their daily activities, thus strengthening misunderstandings in the nurse-patient relationships. The purpose of the current research is to perform the concept analysis of the transcultural nursing theory developed by Madeleine Leininger. To conduct this investigation, the author used a deep and thorough literature review to study major concepts of the theory and investigated its reliability and applicability in different nursing settings and nursing-related fields. The findings have shown that there are different challenges nurses can face while working with the patients from diverse cultural backgrounds. Furthermore, it was discovered and analyzed that the transcultural concept is applicable to different settings and nursing researches. Leininger’s transcultural theory offers a unique approach to work with representatives of diverse folks. Moreover, the theory with its methods of data collection can serve as the helpful instrument while conducting a research into nursing.
Concept Analysis of Leininger’s Nursing Theory
The most enduring problems related to nursing include clinical observation of poor quality and low integration of nursing theories into practice in terms of transcultural environment. It happens due to the lack of cultural competence. The majority of people do not think that cultural care is necessary for providing health care services. However, owing to different kinds of barriers, patients from different cultural backgrounds remain unsatisfied and misunderstood. Thus, the transcultural theory of nursing developed by Madeleine Leininger becomes widely spread due to its reliable approaches ensuring patients’ well-being regardless of their religion, beliefs, and value systems. An application of the theory in daily practices will reduce shortcomings in caring, improve understanding between nursing staff and various patients, and enhance the overall quality of health care. Regarding the necessity to promote cultural competence among young and experienced nursing personnel, it is important to determine what approaches would be applicable to a range of settings. Therefore, the paper focuses on the concept analysis of Madeleine Leininger’s transcultural theory and its application to nursing practice and other nursing-related fields.
The cultural or transcultural concept of caring is based on the knowledge about individuals and groups from different cultural environments and their care in diverse institutions of health care systems. Leininger’s theory is distinctive because it is built on the socio-cultural and linguistic competence . In other words, one can define it as the use of culturally specific definitions and expressions related to health care. Another focus of the concept is people, nursing, and professional care systems. Such division into the categories is essential for practice because it contains the characteristics of each system along with specific requirements and guidance on care provision. Moreover, it allows to define similar and distinctive elements of cultural care or cultural care universality and diversity respectively . The aforementioned two definitions are decisive in daily nursing practices.
A number of health care institutions and nurses do not pay particular attention to cultural care. This position may have an excuse that people do not fundamentally differ in terms of their basic needs, so there is no necessity to develop or find specific approaches to caregiving. However, it is a gross misconception to overlook the importance of this factor. Since health care is linked to psychological, emotional, and mental basis in general, the interconnection of nurse’s and patient’s beliefs and values has to be established accordingly to provide holistic care and meet patients’ needs. Therefore, cultural care is associated with medical personnel’s understanding and recognition of cultural and religious divergence of a patient. In turn, it involves a continuous research of lifestyles and customs of different cultural communities to find a common language with patients and communicate with them respectfully. In view of this, cultural diversity means a response to multicultural characteristics of the patient population. Universality includes the expressions related to care existing in a particular culture and influence on the perception of care. For instance, different policies forming a national health care serve as an example of universality. Generally, principles of care diversity and universality make nurses consider and recognize the beliefs and cultural background of every patient and integrate them into a treatment plan to enhance curing.
This background is crucial for nurses who mainly work with representatives of different cultures. The setting that will be described in detail below analyzes an experience that is challenging and frustrating enough even for highly skilled professionals with rich nursing expertise (Amiri, Heydari, Dehghan-Nayeri, Vedadhir, & Kareshki, 2016). Hence, the theoretical knowledge should be applied not only when nurses work in foreign countries, for example, when they serve as volunteers of health care educational programs or interventions in the third-world countries. Amiri et al. (2016) define the migration as the first cause of cultural diversity in various societies. Therefore, it is no wonder that such conditions have a huge impact on health care systems. As it was mentioned earlier, Leininger’s transcultural theory is focused on minimization of the cultural barrier while delivering health care services and maximization of quality of the care.
Apart from the general notions, the transcultural theory of caregiving has its major concepts that are explicitly incorporated in the nursing practice. Some of them, such as care universality and diversity, were described above, but there is a range of other definitions that form a basic framework of cultural care. The major concepts include different notions essential in comprehensive understanding and building a practical framework in nursing and caregiving. Thus, transcultural nursing refers to a branch focusing on the comparative analysis of cultures and their characteristics as well as on their incorporation into a set of caring practices and values. It is aimed at provision of meaningful and effective nursing care services . Ethnonursing, in turn, studies nursing care practices, beliefs, and values as cognitively perceived by a certain culture through their value system, experience, and beliefs . The rest of major concepts reflect the understanding of nursing in terms of the diverse multicultural environment. As one can notice, working in this environment becomes a frequent experience for nurses; thus, an understanding of the main principles will minimize shortcomings in caring for the patients from different cultures.
Returning to the concept of culture care universality and diversity, it is worth mentioning that it was developed from observing pediatric patients from diverse cultural backgrounds and analyzing their response to health care specialists in a child psychology setting . Having observed the situation, Leininger noticed that children who have a multicultural background do not respond in the same way as children with the nurse’s background . Interestingly, those children responded negatively in comparison to the others. Therefore, it pushed the investigation and evolvement of the theory to a higher level because the same treatment plan for different patients cannot have the same positive outcomes and effective recovery. Much depends on communication between the patient and the caregiver, the ability of both to collaborate while accepting the treatment plan, and acknowledgment of patient’s values and beliefs that should be considered in the caring process.
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To prove the theory’s relevance, it is necessary to begin from its application to appropriate settings. Leininger’s transcultural concept can be reliable in various settings. During the literature review, three settings (i.e. patients with chronic diseases, diagnoses and treatment, genital and rectal problems) were chosen to observe how the transcultural theory can be applied to the specific issues. It is important to implement the major concepts into daily practices because each setting is unique and poses various challenges that should be prevented or overcome. For example, following the concept’s direction would help to minimize the communication barriers that are common for different settings in health care services delivery. Apparently, one type included language barriers as many patients used different languages or dialects completely unknown to health care workers. Logically, it is hard to understand a foreign language without learning it. Moreover, some explanations of health care procedures or activities are impossible both to be understood by a patient and to be given by a care provider. Additionally, the second type of the barriers is associated with diverse interpretation of disease symptoms and other signs used between personnel and patients. The representatives of different cultures confused health care staff with their perceptions and expressions of symptoms. Frequently, the patients could not explain what they felt due to their own understanding of a particular symptom or their embarrassment to give such information to the practitioners and nurses. In this case, the application of the theory should be focused on finding a common language all the way to hiring a translator, learning the language, etc. Establishing a contact between a patient and a nurse is one of the major principles of the transcultural theory that has to be applied.
Patients with chronic diseases setting. This setting is very important because the patients need constant examination and care to keep their health in a normal state. The reason for implementation of Leininger’s theory is irregular follow-ups revealed during the investigation. Due to this situation, immigrants were indicated as patients having more developed chronic diseases. Again, one of the reasons for that is misinterpretation of information and general misunderstanding because of the cases mentioned above. Another reason belongs to the inability of many immigrants to afford comprehensive treatment. Iranian health care services are highly expensive for immigrants, especially, when they live in severe poverty and have no insurance respectively. Moreover, the legal conditions in Iran require the residential permit for immigrants; thus, non-registered people have no right to visit the public clinics or hospitals even in emergency cases. Therefore, it makes sense to make a request to the government, asking to make health care services more accessible for the patients. Even the theory in question suggests that everyone deserves high-quality care that has to be affordable. The situation becomes worse when many immigrants themselves are careless about their health. Notably, many of them ignore the health problems until they are accidentally found. Such circumstances underline the necessity to find approaches not only to care but to educational activities for the population. People should know what to do in some cases and how not to be afraid to ask health care providers for help and guidance.
Diagnosis and treatment setting. Diagnosis and treatment are core activities ensuring the patient’s recovery and well-being. The application of the transcultural concept in this setting is caused by mistrust to healthcare personnel. The lack of trust was expressed in different ways but the most common ones were related to a range of beliefs or behaviors. A significant number of immigrants believe that when a doctor prescribes more drugs, he or she has diagnosed an illness better; others frequently change their practitioner or nurse and ignore recommendations of experts. Amiri et al. (2016) noticed that many low-educated patients were sure that injections are more effective than pills or other medicines, so they asked to be injected very often. The problem deteriorates with immigrant’s sharp rejection of trainings or educational meetings and talks due to their general mistrust to health care professionals and better trust to neighbors or friends. It is obvious that this serious cultural issue requires that some possible alternative approaches to manage those patients are found. Their beliefs and opinions grounded mainly on illiteracy and a strong feeling of belonging to their traditions are more powerful than it may seem, which significantly hinders health care practices. However, one can notice that the lack of proper communication skills is evidenced. Therefore, the application of the theory should be based on finding the methods to influence the patients and their beliefs and make them want to know about their health. Theoretically, health care providers must become patients’ friends . Therefore, it is essential to promote cultural competence in order to enforce the efforts of the personnel to find the ways to communicate with the patients.
Genital and rectal problems setting. This setting is the most challenging among others because it relates to the problems that people are embarrassed to discuss. Quite often, immigrants’ cultural-personal traits do not allow them to talk about such sensitive matters. Therefore, implementation of the transcultural theory is crucial for this kind of setting because when a patient has a problem, he or she has no need to be afraid to discuss it with an expert. For instance, being shy to tell the professionals about some health concerns was much impeding to an appropriate care provision. It was especially common for genital and rectal problems. Amiri et al. (2016) emphasized that women expressed shyness more while discussing their health state; however, such tendencies were also indicated in men. For instance, religious beliefs in Iran restricted females to be examined by males. Hence, the patriarchal principles determined men’s decisions about treatment of women. Apparently, the cultural peculiarities make some interventions or surgeries in genitals impossible, even if an illness poses a serious threat to further well-being or even life of a person. Furthermore, most immigrants have poor communication skills and are isolated from others. Undoubtedly, it does not help to establish a common language and harms their health, not to mention misunderstandings with health care experts. Again, the problem lies in a poor communication. It is the staff that bears the responsibility for patient’s well-being, which presupposes that a medical worker must find the ways to understand a patient.
Application of the Theory in Future Practice
If the world becomes more globalized every day, this will influence each sphere of life, and nursing care and health system is not an exception. The example of Tollab area in Mashhad described earlier has shown that multiculturalism poses a range of barriers and discordances in caregiving both for patients and nurses. Therefore, the ultimate goal for the health care system and my future experience should be a minimization and avoidance of such discrepancies in the future practice . The recognition of possible barriers and finding culturally and linguistically applicable methods will contribute much to the improvement of the situation.
Working in a multicultural environment is highly interesting and can be well-paid, but it is a good career option only if the care provided complies with the standards and one’s cultural competence. Leininger’s cultural care diversity and universality represent a well-structured approach to a culturally congruent care promotion . Therefore, the basic principle of my future practice is avoidance of expressing my own beliefs to a patient. I would prefer to fit myself to the patient’s requirements to understand him or her, learn the basic expressions of states, and gain trust. Thus, it is a matter of the utmost importance to pay special attention to self-development in terms of cultural competence.
Not surprisingly, every cultural group practices own original folk healing procedures based on their beliefs or traditions. There is no need to implement those procedures into the future practice; however, it is essential to bridge them to create a basis for culturally congruent care. Therefore, before delivering health care services, I would conduct a research to gain enough knowledge and be aware of beliefs, practices, and expressions of some people for my further professional development . In particular, it is essential to determine what attitudes, phrases, expressions, and other issues pertaining privacy, illnesses, dietary, health, death and grief, and other emotional and physiological states are acceptable for a particular cultural community.
Additionally, employment of the three modes of action in the future practice enforces critical thinking and judgment regarding making diagnoses, treatment plans, implementations, interventions, and other activities in terms of cultural congruency that is helpful for the advancement of professional skills. One of the first modes of nursing practice to be applied is a revision of diagnoses with a purpose to make them culturally acceptable and sensitive for diverse patient communities (Leininger & McFarland, 2013; Wayne, 2014; Sagar, 2012). In other words, I should rely on maintenance and preservation approach implying that generic ways of treatment or another component of care would be more advantageous than the professionally accustomed one. As it was discussed earlier, communication between a nurse and a patient is a prerequisite for an appropriate way to caregiving and recovering. Thus, I have to employ accommodation and negotiation modes offered by Leininger when interventions including adaptation should be negotiated with patients personally or within groups. Additionally, I would promote culturally congruent care through education of patients related to preventing or coping with diseases, recovering from someone’s death, or development of healthy habits . For instance, when a patient has high blood pressure, he or she can be informed that garlic can soften this symptom, though it does not deny the prescribed intake of medications. The third mode, i.e. restructuring and repatterning employment in my daily practices will refer to making decisions together with a patient, which can be related to modification or changes of the treatment plan or other caring issues to improve the health outcomes. The transcultural nursing theory becomes more popular and important in terms of its application in future practices and will help many professionals to enhance their nursing career.
Application in Nursing-Related Fields
Leininger’s transcultural theory is applicable to conducting a nursing research. For example, the method of ethnonursing makes a significant contribution to the whole body of the concept and knowledge of nursing. The cultural theory encourages the participatory method in the process of the research. Notably, Madeleine Leininger developed the principles, so-called enablers, referred to the stranger-friend relation and observation-participation-reflection. It would be essential in the situations described by Amiri et al. in Mashhad, Iran (2016), despite their primary connection to the research rather than to the nursing practice. However, the ethnonursing approach encompasses moving from being a stranger to a friend that is helpful in collecting meaningful and accurate information . Fundamentally, the model with enablers is suitable for any research conducted in different settings. The application of the ethnonursing method in an investigation promises a possibility to meet a range of criteria such as credibility, context consideration, confirmability, and many other factors that are linked to the qualitative research.
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The analysis has shown that foremost healthcare providers should be the best not only in making a diagnosis and providing treatment but also in leading experts in the area of cultural sensitivity. Every patient deserves the most effective medical care independently of his or her cultural background, religion, values, perceptions, and beliefs. Moreover, these people should be treated by the nurses who respect and consider the needs of their patients. Therefore, in the circumstances of rapidly developing world globalization, the transcultural nursing theory suggested by Madeleine Leininger becomes one of the leading paradigms for care provision to patients from different cultures. The core principle of the concept is to combine nursing care with the cultural approach. Sometimes, it poses a challenge for both inexperienced and skilled nurses; however, Leininger’s theoretical framework helps to find answers to these questions. The observation of different settings helped to determine and fully understand that finding approaches is simple theoretically but is rather problematic in a real practice. Thus, the incorporation of culturally congruent care into daily practice plays a crucial role in the professional development of a care provider.